Elderly status epilepticus

There are an estimated 150,000 cases of SE each year in the United States, with approximately 55,000 associated deaths, and an estimated annual direct cost for inpatient admissions of 4 billion.4,5 Status epilepticus occurs more frequently in African-Americans, children, and the elderly. Additional attention should be given to elderly individuals with SE, as other underlying disease states may complicate therapy and worsen prognosis.6... 

Central nervous system adverse effects are common with felbamate, and consist mainly of insomnia, headache, impaired concentration, ataxia, dizziness, somnolence, behavioral disturbances, and mood changes. Movement disorders, psychosis, increased seizures, status epilepticus, and withdrawal seizures are less common (SEDA-19, 67) (SEDA-20, 61). The incidence of these effects is increased in the elderly, possibly owing to reduced drug clearance (4), whereas patients with mental retardation may be more prone to behavioral disorders (SEDA-19, 68). 

DeLorenzo RJ, Towne AR, Pellock JM, Ko D. Status epilepticus in children, adults, and the elderly. Epilepsia 1992 33 S 15-25. 

Fosphenytoin sodium (Fig. 20.5) is a soluble pro-drug disodium phosphate ester of phenytoin (142 mg/mL) that was developed as a replacement for parenteral phenytoin sodium to circumvent the pH and solubility problems associated with parenteral phenytoin sodium formulations (36,37). Unlike phenytoin, fosphenytoin is freely soluble in aqueous solutions and is rapidly absorbed by the IM route. It is rapidly metabolized (conversion half-life, 8-15 minutes) to phenytoin by in vivo phosphatases. Therapeutic free (unbound) and total plasma phenytoin concentrations are consistently attained following IM or IV administration of fosphenytoin (26). It is administered IV following benzodiazepines for control of status epilepticus or whenever there is a need to rapidly achieve therapeutic plasma concentrations. Severe bradycardiac adverse events to fosphenytoin, including some fatalities, have been reported (38). A dose reduction in patients who are elderly or have renal or hepatic impairment has been suggested. 

A. Ataxia, nystagmus, ophthalmoplegia, movement disorders (dyskinesia, dystonia), mydriasis, and sinus tachycardia are common with mild to moderate overdose. With more serious intoxication, myoclonus, seizures (including status epilepticus), hyperthermia, coma, and respiratory arrest may occur. Atrioventricular (AV) block and bradycardia have been reported, particularly in the elderly. Based on Its structure similarity to tricyclic antidepressants, carbamazepine may cause QRS and QT interval prolongation and myocardial depression however, in case reports of overdose, QRS widening rarely exceeds 100-120 msec and Is usually transient. 

The short-term effects of intravenous levetiracetam as the treatment of choice for status epilepticus have been evaluated in nine elderly patients (five women median age 78 years) [197 ]. In all but one, intravenous levetiracetam was effective and there were no adverse reactions or changes in electrocardiography or laboratory parameters. 

Fattouch J, Di Bonaventura C, Casciato S, Bonini F, Petrucci S, Lapenta L, Manfredi M, Prencipe M, Giallonardo AT. Intravenous levetiracetam as first-line treatment of status epilepticus in the elderly. Acta Neurol Scand 2010 121(6) 418-21. 

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